Magdi Yacoub Heart Foundation

Septal myectomy is a well-established surgical intervention for patients with hypertrophic obstructive cardiomyopathy (HOCM). However, mitral annulus dynamics in HOCM patients and the procedure's impact on them are not fully understood. This study aimed to evaluate the mitral valve annulus's dynamics and the effect of septal myectomy on its geometry and function using three-dimensional transesophageal echocardiography (3D TEE) in HOCM patients. A single-site, prospective observational study was conducted at a tertiary-level hospital; 26 patients with HOCM who underwent septal myectomy were included. Intraoperative 3D TEE was performed before and after surgery to assess mitral annular dimensions, area, and motion. Clinical outcomes, including New York Heart Association (NYHA) functional class and left ventricular outflow tract (LVOT) gradient, were also evaluated. Preoperative and postoperative transesophageal images were analyzed offline to measure mitral annular dynamics across the cardiac cycle using dedicated software and Doppler-derived pressure gradients. Throughout the four phases of the cardiac cycle (late diastole, early systole, mid-systole, and late systole), there were no significant dynamic changes in mitral annulus dimensions, specifically, the anteroposterior (AP) diameter (p = 0.286), anterolateral-posteromedial (AL-PM) diameter (p = 0.922), sphericity index (p = 0.311), inter-trigonal diameter (p = 0.982), intercommissural diameter (p = 0.999), 3D saddle-shaped annulus area (p = 0.714), 3D saddle-shaped annulus perimeter (p = 0.754), annulus height (p = 0.981), nonplanar angle (p = 0.902), aorto-mitral angle (p = 0.949), and saddling (p = 0.231). Immediately after septal myectomy, despite significant LVOT gradient reduction (88.4±45.6mmHg preoperative vs. 9.3±4.7mmHg postoperative; p<0.001), no significant improvements were detected in mitral annular parameters (p>0.05 for all parameters). 3D TEE offers critical insights into the dynamics of the mitral valve annulus across various phases of the cardiac cycle. In patients with HOCM, the mitral valve annulus exhibits reduced dynamic motion, with a notable loss of normal systolic AP contraction and saddling. Immediate postoperative assessments did not demonstrate significant improvements in mitral annulus dynamics. Therefore, further longitudinal studies are necessary to assess long-term changes in mitral annulus dynamics due to LV remodeling following septal myectomy procedures.

Abstract Background Ventilator-associated pneumonia is the most serious acquired infection in intensive care units for patients undergoing mechanical ventilation following urinary tract infections. The mortality associated with VAP ranges from 20% to 50%, and the attributable mortality is estimated at 13%. And the knowledge of nurses working in critical areas regarding the VAP prevention bundle is not well established. This study determined the knowledge level of the VAP bundle among nurses working in cardiac critical areas. Methods A cross-sectional study design with a quantitative approach was used. A convenient sampling method was used in selecting study participants and was conducted in the adult cardiac intensive care unit and the Cardiac care unit. Participation was voluntary, and a sample of 67 nurses was selected. A structured questionnaire was used in data collection, and SPSS version 21 was used in data analysis. The data was collected in the first week of September 2025. Results Regarding the sociodemographic characteristics of the study participants, most of the study participants were aged below 24 years (58.2%), and the mean age of 25.2687. The majority of the participants were working in ACICU (85.1%). The Overall knowledge level, about 80.6% of the studied subjects had a satisfactory knowledge level (61–100% score). Computed multivariate binary logistic regression analysis, the result showed a significant relationship between the workplace, not attending the VAP or IPC training and frequency of ventilator circuit change were statistically significant with nurses’ VAP knowledge level with OR: 0.032 (C.I:0.01–0.200), p value 0.000; OR: 0.040(C.I:0-0.33), p value 0.003, and OR: 0.043 (C.I:0.000-0.660), P value 0.024 respectively Conclusion The overall nurses’ knowledge level towards VAP was satisfactory, especially for those working in ACICU. And the factors associated with nurses’ VAP knowledge level, workplace, having attended or not VAP/IPC training, and changing ventilator circuit frequency were statistically significant.

Accurate assessment of myocardial viability is crucial for guiding treatment decisions in patients with ischemic cardiomyopathy (ICM). Delayed gadolinium enhancement (DGE) is the current gold standard, but non-contrast methods like feature tracking (FT) analysis during dobutamine stress are emerging. This work evaluates the efficiency of myocardial viability assessment using cardiac magnetic resonance feature tracking (CMR-FT) during stress by low-dose dobutamine. This retrospective case-control study enrolled 50 ICM patients who underwent CMR at rest and during low-dose dobutamine stress. FT analysis was performed to assess circumferential, radial, and longitudinal strain at both rest and stress. DGE was used as reference to determine viability. Significant strain improvement with dobutamine was observed in segments deemed viable by DGE, while non-viable segments showed no improvement. CMR-FT during low-dose dobutamine stress shows promise as non-contrast method for assessing myocardial viability in ICM patients, providing a potential alternative to DGE.

Abnormalities of the left ventricular papillary muscles, albeit rare, can be clinically significant. We report two pediatric cases with thickened, fused papillary muscles obstructing left ventricle inflow with abnormal attachments to the ventricular septum leading to midcavitary outflow obstruction. Surgical management, consisting of septal myectomy, splitting of hypertrophied muscles, and resection of fibrous adhesions, successfully relieved obstruction. These cases underscore the importance of considering papillary muscle abnormalities in the differential diagnosis of midcavitary obstruction.

Hypertrophic cardiomyopathy (HCM) is an inherited cardiac disorder characterized by left ventricular thickening and extracellular matrix (ECM) remodeling, often manifested as increased interstitial fibrosis that impair muscle function. The clinical and pathological presentations, as well as the genetic background, vary among patients, making HCM a heterogeneous disease with diverse clinical phenotyping and responses to treatment. In HCM, the myocardium exhibits an increased secretion of inflammatory mediators and ECM proteins, indicating a stress response to myocardial pathogenesis. The production of these ECM proteins is regulated by the interaction between cardiomyocytes and the surrounding stroma, including cardiac fibroblasts, immune cells, and microvasculature. This crosstalk defines the responsiveness to injury and the progression of the disease. In this review, we aim to dissect the composition of myocardial ECM in relation to HCM development, highlighting the key cellular contributions to ECM remodeling and identifying potential molecular targets for personalized diagnostics and therapeutics.

The global trend of population aging has resulted in more frequent cardiovascular disease among seniors. Primary percutaneous coronary intervention (pPCI) is the standard of care for ST-elevation myocardial infarction (STEMI) without an upper age limit. Nevertheless, the outcomes are variable among studies, and data on pPCI outcomes in the elderly in Africa is scarce. Thus, we attempted to gain better insight into the outcomes of primary PCI in this age group from a single center in upper Egypt. To study the patient characteristics and in-hospital outcomes of pPCI in elderly patients presenting with STEMI in a tertiary cardiac center in upper Egypt. This observational cohort study was based on data from the pPCI registry in a tertiary cardiac center in upper Egypt, which included 3,627 consecutive patients who underwent pPCI between January 2014 and June 2023. The elderly were defined as those aged 70 years or older and represented 15.9% (575 patients) of the entire cohort, of whom 103 (2.8%) were octogenarians. Clinical characteristics, procedural details, and in-hospital outcomes were compared between the age groups. The elderly had a significant trend of being female and hypertensive, and having chronic kidney disease (CKD), worse Killip class, more frequent severe non-culprit vessel lesions, and left main trunk involvement. The in-hospital mortality was significantly higher than that of younger patients (14.1 vs. 4%, p = <0.001), with higher mortality in octogenarians (23.3%). Killip class ≥II was independently associated with increased hospital mortality in all study age groups. Contrast-induced nephropathy and TIMI major bleeding were also significantly higher. Compared to younger patients, elderly patients undergoing pPCI had a higher prevalence of hypertension and CKD and were more likely to have a worse Killip class. The radial approach was utilized less often in the elderly group. In-hospital complications and mortality, particularly among the octogenarians, were significantly higher than in younger patients.

Background: After acute myocardial infarction (AMI), physicians typically address traditional coronary artery disease risk factors such as LDL-C, smoking, hypertension, and diabetes. However, residual inflammatory risk may be overlooked. Low-dose colchicine has been shown to reduce stroke and recurrent angina requiring revascularization in clinical trials, but real-world data is limited. This study aims to evaluate the use of colchicine post-AMI and its impact on cardiovascular outcomes. Methods: We utilized the TriNetX database (January 2006 to January 2023) to include all new AMI patients aged ≥18 years who underwent revascularization, comparing those started on colchicine post-AMI to those who were not. Baseline characteristics were assessed. At a 5-year follow-up, outcomes such as death, cardiac arrest, recurrent AMI or revascularization, heart failure (HF), stroke, new-onset atrial fibrillation (AF), and diarrhea were evaluated. Results: Out of 151,182 patients, 3,099 (2%) were started on colchicine after the index AMI. The mean ages were 64.7±12.1 years for the non-colchicine group and 65.6±11.8 years for the colchicine group. At 5 years, the colchicine group had a lower incidence of composite cardiovascular outcomes (56.3% vs. 82.6%, p &lt; 0.01). Specifically, recurrent AMI/revascularization (12.4% vs. 71.2%, p &lt;0.01), cardiac arrest (2.7% vs. 5.3%, p&lt;0.01), and stroke (5.8% vs. 7.3%, p&lt;0.01) were lower in the colchicine group. However, new-onset AF was higher in the colchicine group (26.8% vs. 21.8%, p&lt;0.01). No significant differences were observed in death (14.3% vs. 15.1%, p=0.25), HF (38.1% vs. 37.7%, p=0.62), and diarrhea (8.5% vs. 8.2%, p=0.62). Propensity matching showed better cardiovascular outcomes for the colchicine group across all subgroups. Conclusion: Colchicine use post-AMI is associated with improved cardiovascular outcomes in a real-world setting, although its utilization remains low.

Background: The long-term outcomes of chronic total occlusion (CTO) percutaneous coronary interventions (PCI) in patients with prior coronary artery bypass graft surgery (CABG) have received limited study. Methods: We examined the baseline characteristics and outcomes of CTO PCIs performed at 47 US and non-US centers between 2012 and 2023. Results: Of the 12,164 patients who underwent CTO PCI during the study period, 3,475 (29%) had prior CABG. Prior CABG patients were older, more likely to be men, with higher incidence of comorbidities and lower left ventricular ejection fraction and eGFR. Their CTOs were more likely to have moderate/severe calcification and proximal tortuosity, proximal cap ambiguity, longer lesion length and higher J-CTO scores. The first and final successful crossing strategy was more likely to be the retrograde approach. They had lower technical (82.1% vs 88.2%, p&lt;0.001) and procedural (80.8% vs 86.8%, p&lt;0.001) success, but similar incidence of in-hospital major complications. The incidence of in-hospital death (0.8% vs 0.3%, p&lt;0.001), acute myocardial infarction (0.9% vs 0.5%, p=0.007) and perforation (7.0% vs 4.2%, p&lt;0.001) was higher in prior CABG patients, while pericardial tamponade was less common (0.1% vs 1.3%, p&lt;0.001). At 2-year follow-up, the incidence of major adverse cardiac events, repeat PCI and acute coronary syndromes was significantly higher in prior CABG patients, while all-cause mortality was similar. Conclusions: Prior CABG patients undergoing CTO PCI have more complex clinical and angiographic characteristics and lower success rate, but similar incidence of in-hospital major complications, and had higher incidence of MACE but similar all-cause mortality during long-term follow-up. Abbreviations: eGFR= estimated glomerular filtration rate

MRI feature-tracking (MRI-FT) can accurately assess ventricular myocardial deformation and regional function and may be a better predictor of mortality than ejection fraction and infarct extension. However, role of MRI-FT in assessing coronary revascularization is unclear. To assess coronary revascularization effect on territorial left ventricle (LV) function of chronic coronary syndrome (CCS) patients by MRI-FT. Prospective. 50 CCS patients (age: 62.22 ± 8.70 years) scheduled for elective percutaneous coronary intervention (PCI), and 30 healthy controls (age: 35.33 ± 11.57 years). 1.5T with balanced steady-state free precession cine sequence. Global and segmental peak systolic longitudinal, circumferential, and radial myocardial strains were quantified in both patient and healthy control groups by an experienced operator using dedicated software. Patients were studied both pre-PCI and 6-month post-PCI and LV territorial myocardial strain values were calculated by averaging the segmental values of each revascularized territory. Student's t-test, paired t-test, Mann Whitney test, and Wilcoxon signed ranks test. Significance was judged at the 5% level. Territorial longitudinal strain showed significant 6-month post-PCI improvement in the left anterior descending (LAD) and right coronary artery (RCA) territories, but there was not in the left circumflex (LCX) territory (LAD: mean - 11.41% ± 3.45% pre, -13.01% ± 3.53% post; RCA: mean - 11.11% ± 2.65% pre, -13.25% ± 2.81% post; and LCX: mean - 15.43% ± 3.97% pre, -16.17% ± 4.38% post, P = 0.215). Territorial circumferential strain showed significant post-PCI improvement in all revascularized territories (LAD: mean - 13.73% ± 6.56% pre, -16.98% ± 6.01% post; LCX: mean - 13.23% ± 4.23% pre, -16.34% ± 3.45% post; and RCA: mean - 11.24% ± 3.36% pre, -13.80% ± 3.51% post). Territorial radial strain showed no significant post-PCI improvement (LAD: mean 22.73% ± 12.38% pre, 21.79% ± 11.55% post, P = 0.541; LCX: mean 27.73% ± 7.95% pre, 29.0% ± 7.25% post, P = 0.264; and RCA: mean 36.68% ± 11.10% pre, 31.75% ± 10.95% post, P = 0.208). Territorial LV systolic function was significantly improved by coronary revascularization in CCS patients. 1 TECHNICAL EFFICACY: Stage 4.

Abstract Background Kidney diseases have been identified as a major threat to patients with cardiac diseases as they can affect 50% of patients with cardiovascular diseases stages 4 and 5. World Kidney Day (WKD) is a global campaign aimed at raising the awareness of the importance of our kidneys. Aim Aswan Heart Centre was celebrating WKD by conducting an educational awareness day aiming to enhance and fill the knowledge gap for healthcare workers and patients. Process This event was divided as follows:Patients and families: nurses in different departments of the facility ran several educational sessions, and patients group discussions to promote the wellbeing of patients and families regarding the Chronic Kidney Disease (CKD) and the 8 golden rules through the utilization of some interactive materials such as videos and educational posters written in Arabic.Healthcare workers: An online session was conducted for all nurses in Aswan Heart Centre to enhance the knowledge background regarding chronic kidney disease. Furthermore, an online survey was completed by the nurses to assess the current understanding of the chronic kidney disease prior the online session. Graph1. Survey result 71 nursing staff took the survey. Data analysis Most of the staff were aware about the kidney health as the average of the correctly answered questions is 67.25% as shown in Chart 1. Recommendation Such event raises the awareness about our kidneys and encourage patients for systematic screening. Additional Content An author video to accompany this abstract is available on https://academic.oup.com/eurheartjsupp. Please click on the arrow next to ‘More Content’ and then click on ‘Author videos’.