Relation between Epicardial Adipose Tissue Thickness Assessed by Multidetector Computed Tomography and Significance of Coronary Artery Disease

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 positive correlation between both epicardial adipose tissue and pericoronary fat thickness and the coronary calcium score. Conclusion: EAT thickness and pericoronary fat thickness can be used in predicting the significance of coronary artery disease.

Value of Platelet to Lymphocytes Ratio in Predicting Angiographic Reflow after Primary Percutaneous Coronary Intervention in STEMI Patient

Background: Acute myocardial infarction is a leading cause of death worldwide nowadays and treatment of choice is primary percutaneous coronary intervention (PCI). No reflow is a complication that increases mortality and morbidity post intervention and one of its predictors is platelet lymphocyte ratio. Aim of Study: To assess relation between admission platelet to lymphocyte ratio (PLR) and angiographic reflow after primary PCI in acute ST elevation myocardial infarction (STEMI). Patients and Methods: This is a prospective study that was conducted from May 2017 to May 2018 at Cardiology Department, Menoufia University Hospital. Sixty patients presented with ST-elevation myocardial infarction who were eligible for primary PCI were enrolled in the study. According to TIMI flow post intervention, patients were arranged into 2 groups: Group 1 (Normal Reflow) included thirty patients with post intervention TIMI flow III and Group 2 (NO Reflow) included thirty patients with post intervention TIMI flow (0, I, II). Comparison between both groups was done regarding platelet lymphocyte ratio (PLR). Result: PLR was significantly higher in patients with coronary no reflow than in patients with normal reflow with a P-value of , timing interval between onset of chest pain to time of intervention and thrombus grading was significantly higher in patients with no reflow than in patients with normal reflow. Conclusion: Pre-intervention PLR is an independent predictor of slow flow/no reflow following PPCI in patient with acute STEMI.

Role of Two Dimension Strain and Strain Rate Echocardiography in Assessment of Rheumatic Mitral Valve Stenosis

Introduction: Current echocardiographic parameters have a limitation in assessing mitral valve (MV)apparatus in rheumatic mitral stenosis (MS) patient. In the current study, we use 2 dimensional (2D)longitudinal strain (S) and strain rate (Sr) imaging in evaluating the papillary muscle longitudinal strain (LS) as an objective and quantitative echocardiographic parameter with high reproducibility in the assessment of MV apparatus in patients with mild to moderate rheumatic MS with preserved ejection fraction (EF%).?Patients and Method: The study included 40 patients with established diagnosis of MS subdivided in to 31 patients with moderate MS (mean age: 32 ± 5) and 9 patients with mild MS (mean age: 31 ± 6). 20 healthy individuals (mean age 31 ± 6) as a control for cases. The mitral valve area (MVA) was estimated using planimetry and pressure half time (PHT) methods. 2D longitudinal systolic S and Sr imaging was carried out for all participants from the apical long axis (LAX), 4 chamber (4C), 2 chamber (2C) views. Global longitudinal systolic S and Sr were estimated by averaging the 3 apical views. Longitudinal myocardial strain of papillary muscle PMs was assessed by the use of the free strain method from apical 4 chamber view for the antrolateral papillary muscle (APM) and apical long axis view for postromedial papillary muscle (PPM).?Results: Patients with MS had significantly decreased longitudinal LV systolic S and Sr in comparison with control group (p Conclusion: Patients with MS and preserved EF% had decreased APM-LS & PPM-LS in comparison with control group, and had decreased longitudinal LV systolic S and Sr when compared with control group. 2D strain as well as Sr imaging might be a useful method for assessment of mitral valve apparatus in patients with MS & preserved EF%.

Assessment of Left Ventricular Torsion in Hypertensive Patients

Background: Hypertension has important effects on left ventricle and its early detection helps to avoid the cardiac complications. LV Twist in systole helps in storing potential energy during diastole;LV untwist releases this energy. Speckle tracking echocardiography (STE) is angle-independent so it allows a more detailed evaluation of myocardial deformation. Objective: This work aimed to assess the left ventricular torsion by speckle tracking in hypertensive patients. Patients and Methods: The study was applied on 40 hypertensive patients and 20 age and sex matched control groups;all had speckle tracking echocardiography of the LV, and the basal and apical rotation were measured to assess the LV torsion. The 18 segments of LV strain were assessed and the net LV global longitudinal strain was calculated and demonstrated as bull's eye figure. Results: Hypertensive patients had higher mean values of both apical rotation and left ventricular twist than control group by a highly significant value (9.76 ± 4.98 vs 4.03 ± 2.15, P value 0.001) and (15.25 ± 4.10 vs 9.90 ± 1.47, P value 0.001) respectively. Hypertensive patients had a higher basal rotation than controls but did not reach a significant value (-6.01 ± 3.25 vs -5.52 ± 2.63, P value 0.558). On the contrary, the global LV longitudinal strain was lower in hypertensive patients than control but did not reach a significant value (-18.48 ± 3.94 VS -19.48 ± 3.57, P value 0.341). Conclusion:Hypertension affects myocardial structure and its systolic and diastolic functions;the left ventricular twist is an essential component of the systolic function that increases in hypertension as an early compensation for the systolic impairment. The detection of these changes achieved accurately by 2-D speckle tracking, can help in monitoring the treatment modalities of the patients for a better direction of treatment and thus, prevent further deterioration.