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Objectives: This study attempts to determine the silent coronary artery disease (CAD) in a sample of Iraqi Kurdish patients diagnosed with rheumatoid arthritis (RA). Methods: A total of 50 such patients from Duhok, Kurdistan region of Iraq, underwent multi slices computed tomography (MSCT) coronary angiography 64 slices to determine coronary artery calcium (CAC) scores and coronary stenoses. Results: 62% of cases had a (CAC) score > zero on non-contrast MSCT scans. Coronary angiograms showed that 26 (52%) of the cases had variable coronary artery stenosis; 17(34%) of them were obstructive (>50% luminal narrowing). The study demonstrated that Inflammatory markers (rheumatoid factor, Anti- cyclic citrullinated peptides, and some cardiovascular risk factors, namely (hypertension and type 2 diabetes mellitus) were significantly related to the presence of CAD in these patients. Conclusions: Patients with rheumatoid arthritis are at increased risk of CAD. This risk is higher in the presence of inflammatory and cardiovascular risk factors.

Objectives: The aim of this paper was to investigate the impact of different variables on the production of antibodies in patients who were infected with Covid-19. Methods: This cross-sectional study was conducted in Duhok City, Kurdistan Region of Iraq. The study was conducted between January 2021 and March 2022. Demographic data were collected via face-to-face interview. Antibody levels were determined using Elecsys Anti-SARS-CoV-2. Results: The levels of antibody were studied in 138 patients. A significant association was found between antibody levels and the age of the participants (r=0.175; P=0.04). Besides, a significant correlation was found between antibody levels and the duration of symptoms (r=0.206; P=0.015). The antibody levels were not associated with gender; history of chronic diseases; marital status or time interval before testing. Conclusions: Different variables that may impact the levels of antibody were studied. Significant associations were found between antibody levels and both age and duration of symptoms. Our results can be used by healthcare providers to focus on patients who are at risk of low antibody production.

Objectives: This work aimed to study the clinical, angiographic profiles and in-hospital outcomes of NSTEMI cases in Duhok, Iraq. Methods: This prospective study involved 283 patients with NSTEMI who were admitted to Azadi teaching hospital/Azadi heart center in Duhok, Kurdistan region of Iraq, between 2021 and 2022. The patient's demographic variables, major cardiovascular risk factors (smoking, hypertension, diabetes mellitus, hyperlipidemia and family history of coronary artery disease), clinical presentation, past history of myocardial infarction/ previous percutaneous coronary intervention (PCI) and drug history were collected. The GRACE risk score was calculated for each patient. Patients were followed up regarding the management strategies (whether conservative or invasive approach), and in-hospital complications and outcomes. Results: The mean GRACE score was 142±26. 70% of cases underwent coronary angiography/ angioplasty, with a mean time to the coronary intervention of 8 days. 17% of the sample had developed different cardiovascular complications, with heart failure being the most common. The mortality rate was 7.4%. Conclusion: The study demonstrated higher complications and mortality rates, especially among patients with higher GRACE scores, compared to rates found in most available studies, particularly in western countries. This finding could be secondary to a suboptimal coronary intervention for NSTEMI in terms of time to intervention and the proportion of patients who underwent it.

Objective: This registry aims to clarify the characteristics and 6-weeks outcomes of patients with STEMI after PPCI in the region. Methods: Data from a total of 151 STEMI patients undergoing PPCI at Duhok heart center, Iraq from 2020 to 2021 was collected. Patient’s demographic, clinical and PPCI profiles were recorded. The major adverse cardiac events (MACE) and left ventricle ejection fraction (LVEF%) outcomes for 6 weeks period was registered. Results: Of the 151 consecutive patients with STEMI who underwent PPCI, 46 (30.4%) were

•This report is unprecedent in treating a shift in medical training, particularly cardiology, in Kurdistan and whole Iraq.•It attempts to motivate a scientific debate to advance post graduate learning process in cardiology.•It distinguishes the apprenticeship from the competency-based approach and encourages a move towards the latter.•It links this shift with the development of competencies determining cardiological advancement.

ObjectivesEarly-onset myocardial infarction constitutes nearly one third of cases of myocardial infarction among Iraqis, which is rather higher than the proportions reported in many Western countries. Thus this study was initiated to investigate the role of some genetic polymorphisms, as well as acquired risk factors in this condition.ResultsA total of 102 Iraqi patients with first myocardial infarction aged 50 years, and 77 matched controls were enrolled. The DNAs of participants were screened for nine polymorphisms, namely: β-Fibrinogen (− 455G > A), Factor XIII (V34L), Plasminogen Activator inhibitor-1 (PAI-1, 4G/5G), Human Platelet Antigen-1 (HPA1a/b), 5,10-Methylenetetrahydrofolate Reductase MTHFR (C677T) and MTHFR (A1298C), Angiotensin-Converting Enzyme (ACE) 287 bp insertion/deletion (I/D), Apolipoprotein-B (ApoB: R3500Q), and Apolipoprotein-E (Apo E: E2/E3/E4), using PCR and reverse hybridization technique. Among traditional risk factors, univariate analysis revealed that smoking (OR 2.86 [95%CI 1.53–5.34]), hyperlipidemia (OR 5.23 [95%CI 2.66–10.29]), and diabetes mellitus (OR 4.05 [95% CI 1.57–10.41]) were significantly higher among patients compared to controls (P

Introduction: The characters of coronary artery disease with its risk factors and coronary angiograms studied elsewhere revealed differences in different populations. We, here, assess the regional characters of coronary artery disease with its major risk factors and coronary angiographic profile in Duhok, Kurdistan region of Iraq. Methods: We conducted this cross sectional study at the Azadi heart center in Duhok, Iraq. A consecutive sampling procedure was used to enroll a total of 300 adult patients with coronary artery disease (145 men and 155 women) who had undergone coronary angiography. Direct interview was used with designed questionnaire to collect demographic, cardiovascular risk factors and angiographic profiles. Results: The mean patient’s age was 55.5 (10.4) years. The most prevalent risk factor was hypertension (55.3%), followed by dyslipidemia (42.7%), type 2 diabetes mellitus (29%), smoking (11%) and ex-smoking (9.3%). Apart from smoking all other risk factors were more frequent in women. Angiographic analysis revealed normal angiograms in (29.3%) versus single vessel disease (23.3%), double vessel disease (14.3%), triple vessel disease (21.3%) and non significant (11.7%). As to the coronary branch involved, the most frequently affected was the left anterior descending artery followed by right coronary artery, left circumflex artery, and left main stem (60.7%, 46.3%, 43.7% and 6% respectively). Conclusion: This study showed that the coronary artery disease tends to occur earlier in our population. Although cardiovascular risk factors were clustered among women, older men showed more aggressive coronary angiographic lesions.

To determine the impact of CYP2C19 genotyping on the occurrence of major adverse cardiovascular events (MACE), in cohort of Iraqi patients on clopidogrel after percutaneous coronary intervention (PCI), a total of 201 Iraqi patients undergoing the latter procedure were enrolled. All enrollees had their CYP2C19 genotyped using polymerase chain reaction and reverse hybridization. Genotyping revealed that CYP2C19 *1, *17, *2, and *8 allele frequencies were, respectively, 0.604, 0.276, 0.117, and 0.0026. After the exclusion of those with 2 loss of function alleles, 186 patients were available for follow-up as long as they were on clopidogrel, or until MACE occurred, which was encountered in 8.6% after a median of 12 months. Among predictors associated with MACE was the carriage of one CYP2C19 loss of function allele {hazard ratio (HR) 8.6 [confidence interval (CI) 3.15-23.4]; P < 0.0005}, hypertension [HR 3.74 (CI 1.06-13.16); P = 0.04], reduced ventricular function [HR 3.88 (1.43-10.54); P = 0.008], and history of previous myocardial infarction [HR 4.9 (CI 1.48-11.33); P = 0.007] by univariate analysis, although only CYP2C19 genotype remained significant by multivariate analysis [HR 11.88 (CI 3.25-43.44); P < 0.0005]. The latter observation favors CYP2C19 genotype-guided antiplatelet therapy and extending the use of alternative antiplatelet drugs to those with single loss of function allele after percutaneous coronary intervention.

Aims The role of apolipoprotein A in early onset ST-segment elevation myocardial infarction is not clear. This study sought to assess the apolipoprotein A in cohort of patients diagnosed with early onset acute ST-segment elevation myocardial infarction and to corelate it with major traditional cardiovascular risk factors. Methods A total of 50 such patients and 40 age and sex-matched healthy controls, both aged less than 50 years with their baseline demographic, clinical characteristics and cardiovascular risk factors were studied. Apolipoprotein A was estimated for all enrollees. Results The mean age of cases was 43.37 ± 5.85 years. The levels of apolipoprotein A among cases were not significantly lower compared to controls (P = 0.52). They were lower among the male, current smokers and the dyslipidemia (P's < 0.05). Considering the apolipoprotein A as the dependent factor, the early onset ST-segment elevation myocardial infarction was associated significantly with the male and the dyslipidemia in linear regression (P < 0.001 and 0.030), respectively. Conclusion Lower levels of apolipoprotein A are significantly related to conventional risk factors in early onset ST-segment elevation myocardial infarction. This apolipoprotein A that particularly develops in young patients with clustering of traditional cardiovascular risk factors should be targeted. Further studies are warranted to determine the diagnostic and prognostic indicators of this apolipoprotein in ST-segment elevation myocardial infarction.

This article addresses the skillfulness role of the interventionist in the Cath lab. It argues that the interventionist plays a crucial role and should possess certain mental-manual dexterity and hand-eye coordination skills. The article suggests a series of measures that collectively determine the successful role of the interventionist in the Cath lab. This is of utmost importance given the sensitive nature of the cardiovascular procedures, the potential costs of its failure for the patient, and the key action played by the interventionist in determining the failure or success of the procedure.

Background: The return rate of supraventricular tachycardia (SVT) to sinus rhythm by the standard Valsalva maneuver (SVM) is as low as 5%–20%. Despite the limited available data in the literature, the modified Valsalva maneuver (MVM) is promising. We tested the effectiveness of the MVM for the emergency treatment of patients with SVT. Materials and Methods: In this cohort prospective study, 93 confirmed SVT cases with mean age of 47.88 ± 15.66 years and female: male ratio (1.73) across multiple centers underwent MVM. The reversion to sinus rhythm after 1 min of the maneuver, in the first or second attempt, was considered to be a success, and other conditions were considered to be a failure. Alternative therapies were administered for nonresponders. Results: The overall success rate of the reversion of SVT to sinus rhythm by using MVM in this study is 47.3%. In addition, the rate was not affected by medical and drug histories, and the rate was not substantially different among the patients having different sociodemographics, blood pressures, and pulse rate statuses. MVM has a high cardioversion rate when used for patients with SVT. We recommend using it instead of the SVM as the first-line nonpharmacologic therapy for SVT. Conclusion: The MVM has a very reasonable cardioversion rate in the setting of emergency treatment of SVT regardless of the associated sociodemographic and medical histories of patients.

To determine the frequency, clinical and laboratory associations of pulmonary hypertension in Iraqi Kurds with sickle cell anemia, a total of ninety four such patients attending a major hemoglobinopathy center in Iraqi Kurdistan were enrolled. All patients were re-evaluated clinically and had their blood counts, HbF, serum ferritin, LDH, renal and liver function assessed. Transthoracic Doppler echocardiography with measurement of tricuspid valve regurgitant jet velocity (TRV) was performed. A TRV in excess of 2.8 m/s was considered for the purposes of this study as indicative of pulmonary hypertension (PH). The prevalence of TRV in excess of 2.8m/s was 10.6%. By univariate analysis: significantly higher reticulocyte count, more frequent blood transfusions and pain episodes were encountered in the PH group as compared to the non-PH group (p = 0.001, 0.045 and 0.02 respectively). Moreover, PH patients had significantly higher mean right atrial area, left atrial size, E wave/A wave ratio and ejection fraction by echocardiography (p = 0.027, 0.037

Background Cardiac complications are among the most serious problems of thalassemia intermedia patients. The current study was initiated to address the latter issue through the study of the echocardiographic findings and correlate it with clinical characteristics of thalassemia intermedia patients in Duhok, Kurdistan region, Iraq. Methods An echocardiographic assessment of 61beta-thalassemia intermedia cases was performed. It included 30 males and 31 females, with a mean age 19.6 ± 7.5 years. The standard echostudy of two-dimension and M-mode measurements of cardiac chambers were done. The continuous doppler regurgitant jet of tricuspid and pulmonary valves were recorded. Left ventricle diastolic function was assessed by pulsed doppler of mitral valve inflow. To correlate the clinical with echocardiographic findings, patients were divided, according to tricuspid regurgitant velocity, into three groups (