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Objective: To evaluate the incidence rate of definite stent thrombosis and major adverse cardiovascular events (MACE) with Ticagrelor versus Clopidogrel in ST segment elevation myocardial infarction (STEMI) patients candidate for primary percutaneous coronary intervention (PCI). Methods: STEMI participants naïve to antiplatelets, with no history of coronary artery disease (CAD) and candidate for primary PCI were included, while participants with history of CAD were excluded. Two hundred consecutive participants were selected, divided into 2 groups of 100 participants each, received either Ticagrelor or Clopidogrel, and followed up at 3 and 6 months. Results: The percent of patients in the Ticagrelor group who developed definite stent thrombosis (in-hospital and total) was 0%, while the percent of patients in the Clopidogrel group who developed definite stent thrombosis (in-hospital and total) was 8% and 9%, respectively. There were statistically significant weak associations between the class of P2Y12 platelet inhibitors and definite stent thrombosis (in-hospital and total) (X2 = 8.33, P = .004, V = 0.204 and Χ2 = 9.424, P = .002, V = 0.217, respectively). The percent of patients in the Ticagrelor and Clopidogrel groups who developed in-hospital MACE was 1% and 9%, respectively. There was a statistically weak significant association between the class of P2Y12 platelet inhibitors and in-hospital MACE (X2 = 6.74, P = .009, V = 0.184). Conclusion: Ticagrelor is more efficacious than Clopidogrel in preventing definite stent thrombosis (in-hospital and total) and in-hospital MACE in STEMI patients.

Both Transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) have well-established role in mitral regurgitation (MR) quantification for optimal management strategy. We assessed the correlation between TTE and CMR in the quantification of MR. Participants with isolated MR and echocardiographic mitral regurgitant volume (RVol) ≥ 30 mL/beat were included. A consecutive sample of 30 participants (Mean age 52.7 ± 19.3 years, 50% males) was selected and referred for indirect and direct CMR quantification of mitral RVol. There was a statistically significant strong positive correlation between the echocardiographic and indirect CMR quantification of the mitral RVol (r = 0.753, P < 0.001) and a statistically significant moderate positive correlation between the echocardiographic and direct CMR quantification of the mitral RVol (r = 0.530, P < 0.003). The inter-observer reliability of the MR grade between TTE and CMR showed a statistically significant moderate agreement (κ = 0.502, P = 0.0001) when the observers used the echocardiographic mitral RVol for grading of MR. On the other hand, the inter-observer reliability of the MR grade between TTE and CMR showed a statistically significant faint agreement (κ = 0.251, P = 0.024) when the observers used the echocardiographic regurgitant fraction (RF) for grading of MR. The positive reciprocal relationship between the CMR and the TTE highlights the potential role of the CMR as a concomitant imaging tool for quantification of the mitral RVol and grading of isolated MR, especially with limited or inconclusive TTE studies. This will enhance the management strategy and improve outcomes.

A multicenter study to evaluate the prevalence and cardiovascular outcomes of diabetic cardiomyopathy in type II diabetic patients. Two hundred participants with type II diabetes mellitus (DM) were included, while participants with coronary artery disease (CAD), valvular heart disease, or history of alcohol or drug abuse were excluded. Participants were subjected to history taking for age, gender, body mass index, smoking, dyslipidemia, medications, DM, Framingham diagnostic criteria of heart failure (HF), comprehensive clinical examination, 12 leads resting electrocardiogram, transthoracic echocardiography and one of the following laboratory investigations: glycated hemoglobin, random blood sugar, fasting blood sugar, or 2-hour 75-gram oral glucose tolerance test. The prevalence of diabetic cardiomyopathy versus (vs) no diabetic cardiomyopathy, left ventricular (LV) diastolic dysfunction grade II and III, systolic dysfunction, and hypertrophy in the study population was 23.0% vs 77.0%, 18.5%, 5.0%, and 8.0%, respectively. There was a highly significant difference between LV diastolic dysfunction grade II and III, systolic dysfunction, and hypertrophy in the diabetic cardiomyopathy group vs no diabetic cardiomyopathy group, with an absolute risk increase of 80%, 22%, and 35% in the diabetic cardiomyopathy group, respectively. There was a highly significant difference between the mean ejection fraction (EF) in the diabetic cardiomyopathy group vs the no diabetic cardiomyopathy group. The mean EF for the diabetic cardiomyopathy group was 5.5% lower than the mean EF for the no diabetic cardiomyopathy group. The prevalence of HF and pre-clinical HF in the diabetic cardiomyopathy group was 65% and 35%, respectively. The mean age for HF was 4.1 years older than the mean age for pre-clinical HF in the diabetic cardiomyopathy group. Smoking was significantly and strongly associated with HF vs pre-clinical HF in the diabetic cardiomyopathy group. Diabetic cardiomyopathy was prevalent in an Egyptian type II diabetic patient population and could be considered a primary myocardial disease predisposing to HF in type II DM., Cilj: Proveli smo multicentričnu studiju kako bismo odredili prevalenciju i kardiovaskularne ishode kod dijabetičke kardiomiopatije (DCM) u bolesnika s dijabetesom tipa 2. Metode: U istraživanje je bilo uključeno dvjesto ispitanika s dijabetesom tipa 2 (DM). Isključeni su ispitanici s koronarnom bolesti srca (CAD), valvularnom bolesti srca ili anamnestičkim podatcima o zlouporabi droga ili alkohola. Nakon anamnestičkih podataka utvrđeni su indeks tjelesne mase, učestalost pušenja, dislipidemije, DM-a, uporaba lijekova te su provedeni procjena dijagnostičkih kriterija zatajivanja srca (HF) prema Framinghamskoj studiji, klinički pregled, 12-kanaln elektrokardiogram u mirovanju, transtorakalna ehokardiografija te jedna od laboratorijskih varijabli: HbA1c, nasumične ili natašte izmjerene vrijednost glukoze u krvi ili rezultat dvosatnog testa oralne podnošljivosti glukoze. Rezultati: Prevalencija u usporedbi s odsutnošću DCM-a, dijastolička disfunkcija lijeve klijetke (LV) II. i III. stupnja, sistolička disfunkcija i hipertrofija u istraživanoj skupini iznosile su, redom: 23,0 % prema 77,0 %, 18,5 %, 5,0 % i 8,0 %. U skupini s DCMom postojala je značajna razlika u učestalosti dijastoličke disfunkcije LV-a II. i III. stupnja, sistoličke disfunkcije i hipertrofiji u usporedi sa skupinom ispitanika bez DCM-a, s apsolutnim povećanjem rizika u skupini s DCM-om za ta stanja od, redom, 80 %, 22 % i 35 %. Pronađena je i signifikantna razlika u prosječnoj vrijednosti ejekcijske frakcije (EF) između skupina s DCM-om i bez DCM-a. Prosječna EF u skupini s DCM-om bila je za 5,5 % niža nego u skupini bez DCM-a. Zastupljenost HF-a i pretkliničke HF u skupini s DCM-om iznosila je 65 % i 35 %. U skupni s DCM-om prosječna je dob kod HF-a bila 4 ,1 godinu viša nego prosječna dob za pretklinički HF. Pušenje je bilo izrazito i značajno povezano s HF-om u odnosu prema predkliničkom HF-u u skupni s DCM-om. Zaključci: DCM je bio zastupljen u egipatskih bolesnika s dijabetesom tipa 2 te se može smatrati primarnom miokardijalnom bolešću koja uzrokuje predispoziciju za HF kod dijabetesa tipa 2.