Abstract Background Atherosclerosis is a generalized disease affecting the small and medium-sized arteries, including coronaries and cerebral vessels. Clinically evident cerebral atherosclerosis is preceded by preclinical arterial wall changes. These changes are characterized by increased stiffness of the arterial wall. Trans Cranial Doppler (TCD) is a non-invasive tool that can assess the hemodynamics of the cerebral arteries. Aim and objectives We aim to detect the presence of asymptomatic cerebral atherosclerosis using transcranial doppler in patients with coronary atherosclerotic coronary artery disease undergoing pharmacological stress perfusion test (using dipyridamole, adenosine, regadenoson), depending upon the absence of Headache during the test as an indirect sign of loss of cerebral vasoreactivity due to atherosclerosis. Methods In this study, 140 patients were divided into headache group (17), and no headache group (123) patients, 49 patients were female (35%), and 91 patients were males (65%). They were sent for pharmacological myocardial perfusion imaging (MPI) for assessment of the coronary artery disease by pharmacological stress myocardial perfusion imaging (MPI) using dipyridamole, adenosine and regadenoson were assigned, and divided into two groups according to the presence of the headache post procedural. Both are examined by TCD to assess the cerebral arteries (MCA & ACA) for atherosclerotic changes. Results By analyzing the data extracted from the examined patients with no headache, the Mean flow velocity of the Right MCA and ACA were statistically significant (P-value = 0.007 & <0.001, respectively). Left ACA mean flow velocity and Pulsatility Index of the same artery were statistically significant (P-value= 0.035 & 0.005, respectively) as well. These data were found statistically significant with age (P-value= 0.005). In the headache group, it was found that none of the TCD parameters for the examined arteries were statistically significant as well as age. Myocardial perfusion imaging was found to be statistically significantly abnormal (P-value= 0.005) in patients with no headache group (65%) if compared with the headache group (29.4%). Collectively, Abnormal TCD parameters were found to be statistically significant (P-value=<0.001) in no headache group (81.3%) if compared with the headache group (29.4%). Conclusions Absence of headache as a common symptom in old age patients post the pharmacological stress test reflects, subtill atherosclerotic changes in the cerebral vessels. This is more evident in our study of patients suffering from documented atherosclerotic coronary artery disease. TCD, as a simple tool (available in almost all Echo machines), can be used by a well-trained cardiologist to obtain and get simple data that helps in discovering such patients. More patients in the headache group is needed in future studies. Moreover, tools with higher sensitivity and specificity, such as CT cerebral angiography or MRA for cerebrovascular circulation, are needed for better assessment of the cerebrovascular circulation.

Abstract Background The world's biggest killer is ischemic heart disease, responsible for 16% of the world's total deaths. Ischemic heart disease is the leading cause of death in Egypt, responsible for 21% of all-cause mortality. Ischemic heart disease is the leading cause of heart failure in Egypt, ranging between 40.9% to 72.5% in different regions in Egypt. Late presentation ST elevation acute myocardial infarction is defined as patients who are diagnosed as ST elevation MI > 12-48 hours after the onset of symptoms. Late presentation ST elevation acute myocardial infarction may lead to myocardial necrosis and scarring due to irreversible damage of cardiac myocytes with subsequent development of heart failure with reduced EF% (HFrEF). There are several methods to assess myocardial viability, including dobutamine stress echocardiography, speckle tracking, Single Photon Emission Computed Tomography (SPECT), Positron emission Tomography (PET) and Cardiac Magnetic Resonance (CMR). The advantage of STE is the possibility to use regional strain curves to quantify the intraventricular synchrony and synergy of myocardial contraction. Early detection of ischemic injury and evaluation of myocardial viability after myocardial infarction (MI) can prevent serious complications, such as ventricular remodeling with development and progressive worsening of heart failure, arrhythmias, and sudden cardiac death. Aim and objectives To formulate cutoff regional strain values between scarred and viable myocardium by speckle tracking validated by SPECT in patients with late presentation MI to predict how far the patient can benefit before proceeding into revascularization. Methods A study was conducted on 40 individuals who presented to the cardiology unit in RIO (Research Institute of Ophthalmology) with late presentation STEMI. Patients were subjected to: - Full medical history, complete clinical examination, standard 12 leads resting ECG, conventional resting transthoracic echocardiography study, automated functional imaging (Speckle tracking) echocardiography (offline) study of left ventricle and Single Photon Emission Computed Tomography Study (SPECT). Result Ischemic segments in SPECT were correlated with regional strain value -9.84±1.323%. Mixed scar and ischemic tissue in SPECT were correlated with the regional strain value -7.45±1.323%. The predominant scar in mixed ischemia and scar tissue in SPECT was correlated with the regional strain value -3.88±1.711%. Totally scarred myocardial segments with aneurysmal wall in SPECT were correlated with regional strain values > 0%. Normal myocardial tissues in SPECT were correlated with regional strain values of 16.61 ±3.942%. Conclusion Speckle tracking echocardiography is a new, reliable, bedside and relatively inexpensive modality for the detection of myocardial ischemia and scar tissue after acute myocardial infarction.

Abstract Background Sudden Cardiac Death (SCD) is a leading cause of mortality globally, especially in high-stress environments such as sports and public gatherings. Immediate cardiopulmonary resuscitation (CPR) and access to Automated External Defibrillators (AEDs) significantly improve survival. However, awareness and readiness remain limited in many countries, including Egypt. Aim The initiative titled “With Our Hands, We Save Lives” aims to raise public awareness and preparedness to respond to SCD, train personnel in CPR and AED use across sports facilities and public venues, as well, to build a national network of trained responders in clubs, gyms, schools, and public areas and strategically deploy AED devices throughout key locations in Egypt. Methods This national campaign is a continuation to the Sudden Cardiac Death Initiative that have been launched in CardioAlex.24 and it is a collaboration between: The Cardiovascular Research Education and Prevention (CVREP) Foundation, The Egyptian Ministry of Health and Population, The Ministry of Youth and Sports, in addition to some civil organizations including the Egyptian Red Crescent, Egyptian Ambulance Authority, and the Egyptian Resuscitation Council This initiative is organized and managed by Expand Company (A member of ICOM Group). Implementation was carried out through structured, hands-on training events and awareness campaigns aligned with major national and international cardiovascular events, supported by trained facilitators and guided by certified CPR and AED protocols. Results To date:1,820 individuals trained across 6 governorates (Alexandria, Cairo, Damietta, Minya, Assiut)Integration with major events after the launch in CardioAlex.24 as World Heart Day, CardioAlex.25, AfricaHealth ExCon 2025, Sudden Cardiac Death Awareness Days in different cities.A cooperation protocol was officially signed in February 2025.Training of MOH personnel and sports sector staff, including medical, psychological, and nutrition professionals. The program is targeting a full rollout over 27 cities, 250 institutions, and an average of 6,000 trained participants per year. The Planned Activities for the next period include more cities like Giza, Gouna and Luxor in addition to Cairo and Alexandria. Conclusion This initiative demonstrates the feasibility and impact of a multi-stakeholder national strategy to reduce SCD incidents through education and preparedness. It serves as a scalable model for other regions with similar healthcare and sports infrastructure.

Abstract Background Transradial access (TRA) has become the preferred route for coronary angiography (CAG) and percutaneous coronary intervention (PCI) due to its favorable safety profile compared to transfemoral access. However, TRA is limited by radial artery occlusion (RAO), anatomical variations, and spasm. The distal ulnar (superficial palmar) approach has recently emerged as a potential alternative with theoretical advantages, yet limited data exist regarding its clinical feasibility and safety. Aim and objectives This study aims to evaluate the feasibility, safety, and clinical performance of the percutaneous trans-superficial palmar artery (distal ulnar) approach for CAG and PCI, in comparison with the standard transradial approach. Methods This prospective, randomized clinical study included 90 patients undergoing CAG or PCI at two Egyptian cardiology centers. Participants were equally randomized to either the distal ulnar (n=45) or radial (n=45) access group. Procedural parameters (sheath insertion time, total procedure time, compression time, and hospital stay), access-related complications, and arterial patency were assessed. A follow-up was conducted at two weeks. Result Baseline demographics and CV risk profiles were comparable between the two groups. The distal ulnar group showed a significantly longer sheath insertion time (153.3 ± 79.8 vs. 68 ± 36.2 seconds; P<0.001), but a significantly shorter compression time (87.1 ± 14.2 vs. 133.6 ± 17.6 minutes; P<0.001) and hospital stay (107.8 ± 14.0 vs. 146.7 ± 31.1 minutes; P<0.001). No significant differences were observed in total procedure time (P=0.096), antegrade flow (P=1.00), or duplex-confirmed arterial patency (P=1.00). The incidence of complications—including pain, numbness, bleeding, hematoma, artery occlusion, or vascular injury—did not differ significantly between groups. Conclusion The distal ulnar approach is a safe, feasible, and effective alternative to the radial approach for CAG and PCI, offering shorter compression time and hospital stay despite a longer sheath insertion time.

Abstract Background Permanent pacemaker implantation (PPI) is indicated for the treatment of conduction abnormalities and rhythm disorders. It implies the deployment of a small electronic device that delivers electrical stimulation to the heart through electrodes. PPI was introduced to Rwanda's healthcare system in 2020, as the first catheterization laboratory was established. Hence, there is a need to analyze its utilization, outcomes, and potential challenges Aim and objectives This study aims to describe the clinical characteristics, indications, and procedural outcomes of patients who underwent permanent pacemaker implantation at King Faisal Hospital, Rwanda Methods This retrospective descriptive study included 111 patients who underwent permanent pacemaker implantation at King Faisal Hospital between December 2020 and June 2024. Data were extracted from medical records, including demographic information, comorbidities, indications for pacemaker implantation, and complications encountered. Descriptive statistics were calculated, and chi-square tests were used to assess significant associations. Result The results revealed that the study population had a mean age of 66.7 years, with 56.8% being female. The most common indication for pacemaker implantation was atrioventricular block (69.4%), followed by symptomatic bradycardia (9%). Dual-chamber and single-chamber pacemakers were used in 85.6% and 9% of cases, respectively, while cardiac resynchronization therapy (CRT) was used in 6 patients (5.4%). The most frequent presenting symptoms were fatigue (58.6%), dyspnea (44.1%), and dizziness (32.4%). Hypertension (59.5%) and diabetes (12.6%) were the most prevalent comorbidities. Complications occurred in 13 patients (12%), while mortality was not reported (0%). Conclusion This study describes patients’ demographics, clinical profiles, and outcomes of permanent pacemaker implantation in Rwanda. The findings highlight atrioventricular block as the most common indication, the widespread use of dual-chamber pacemakers, and the range of adverse outcomes encountered. These results underscore the need for continued research and resource allocation to optimize patient care and procedural outcomes. This research contributes valuable insights to the broader understanding of emerging experiences in cardiac interventions within Africa.

Abstract Background Coronary artery bypass grafting (CABG) surgery is a commonly recommended procedure for treating coronary artery disease (CAD). While different conduits have been utilized in CABG, the left internal mammary artery (LIMA) has emerged as the preferred graft for bypassing the left anterior descending (LAD) coronary artery. Methods This is a prospective study carried out in the cardiac surgery departments at Cardiac Center, Althawra Modern Hospital, Sana'a, Yemen, from February 2022 to March 2024. Aim and objectives In this study, we compared the two harvesting techniques in terms of the occurrence of postoperative sternal wound infections. Patients The patients were categorized into two groups based on the method used to harvest the LIMA: Group 1 consisted of 100 patients who underwent pedicled LIMA, while Group 2 included 100 patients who underwent skeletonized LIMA. Exclusion Criteria The study excluded patients with previous adult cardiac surgery, hepatic/renal /Pulmonary failure, Malignancy, emergency surgery, minimally invasive direct CABG "MIDCAB",off-pump CABG, patients with HbA1c more than 7, patients with BMI more than 30, and patients with RIMA harvesting. Result Skeletonized LIMA was significantly associated with a lower rate of sternal wound infections (SWI) compared to pedicled LIMA (9% vs. 36%, P = 0.001). Specifically, there was a significant difference in the incidence of superficial sternal wound infections, with 9% in the skeletonized LIMA group versus 20% in the pedicled LIMA group. Additionally, the rate of deep sternal wound infections was notably higher in the pedicled LIMA group (16%) compared to the skeletonized LIMA group (0%). Conclusion Sternal wound infection is a serious, potentially life-threatening complication following cardiac surgery, often leading to high morbidity and mortality. Preventing this complication requires a comprehensive approach. The skeletonization harvesting technique should be considered for patients with risk factors that may impair sternal healing, such as obesity and diabetes mellitus, as this study demonstrated that it reduces the risk of postoperative wound infections more effectively than the pedicled technique.

Abstract Background In Egypt, non-communicable diseases account for 82% of all deaths and 67% of premature deaths. Suboptimal self-management and low medication adherence lead to higher rates of morbidity and mortality in these patients. Digital health solutions offer a promising avenue to improve patient engagement and treatment outcomes across multiple chronic conditions. Aim and objectives To evaluate the effectiveness of the Elfie app, a comprehensive digital health solution, in improving disease control, medication adherence, and patient engagement across multiple chronic conditions in Egypt. This application is endorsed by the Cardiovascular Research Education Prevention (CVREP) Foundation and the Egyptian Society of Cardiology (EgSC). Methods This observational study analyzed anonymized aggregated data from users of the Elfie app over 6 months. The app provides medication reminders, health parameter tracking (blood pressure, blood glucose, cholesterol), and personalized health tips. Primary outcomes included changes in disease-specific health parameters, medication adherence rates, and user engagement metrics. Result Over 6 months, Elfie's overall effectiveness was evident, with a 40% increase in medication adherence and significant health improvements noted across multiple conditions. For hypertension, the mean systolic and diastolic BP of uncontrolled patients decreased by 34/16 mmHg (from 155/96 to 121/80 mmHg), respectively, with an increase in controlled BP among hypertensive patients by 61%. In diabetes management, mean fasting blood glucose declined from 195 mg/dl to 128 mg/dl and HbA1c from 8.3% to 7.8%, while users with hypercholesterolemia saw a mean LDL-cholesterol reduction of 45.9% (207-112 mg/dl). Also, users experienced a decrease in BMI of 0.87%. Engagement metrics showed a retention rate of 40.12% after one month. Conclusion The Elfie app significantly improved disease control and medication adherence across multiple chronic conditions in Egypt. These findings suggest that comprehensive digital health solutions can effectively support chronic disease management and potentially reduce overall health risks.

Abstract Background Postoperative myocardial infarction (MI) is a recognized complication of oesophagectomy, associated with significant perioperative morbidity and mortality. Despite advances in surgical and perioperative management, contemporary data on its incidence and associated risk factors remain limited. Aim and objectives To determine the incidence of postoperative MI following oesophagectomy at Norfolk and Norwich University Hospital (NNUH), and to identify associated demographic and perioperative risk factors. Methods A retrospective analysis was conducted using a prospectively maintained database of 526 consecutive patients who underwent either minimally invasive oesophagectomy (MIO, n=273) or laparoscopic-assisted oesophagectomy (n=253) between January 2013 and December 2023. Postoperative MI was defined as a new diagnosis within 30 days of surgery, confirmed by clinical, biochemical, or radiological criteria. Demographic, operative, and postoperative variables were analysed descriptively. Result The overall incidence of postoperative myocardial infarction (MI) was 4.2% (22 out of 526 patients). Subgroup analysis showed a notably higher incidence following minimally invasive oesophagectomy (MIO) at 7.3% (20/273), compared to 0.8% (2/253) in those who underwent laparoscopic-assisted oesophagectomy. Among the 22 patients who developed postoperative MI, risk factor analysis revealed that 90.9% (20/22) had a prior history of MI and were male, 81.8% (18/22) had an operative duration exceeding 600 minutes, 22.7% (5/22) were older than 75 years, 13.6% (3/22) experienced an anastomotic leak, and 4.5% (1/22) developed postoperative pneumonia. These findings are consistent with international data reporting MI incidence rates between 4% and 12%, underscoring the influence of both patient-specific and procedural factors. Conclusion Postoperative MI occurred in 4.2% of oesophagectomy patients at NNUH, predominantly among those undergoing MIO. Prior cardiac history, male sex, and prolonged operative duration were key risk factors. Accurate differentiation between pre-existing and new-onset MI remains essential for risk stratification. Optimization of perioperative cardiac risk management protocols is recommended.

Abstract Introduction Venous thromboembolism (VTE) has an increasing incidence worldwide, particularly among cancer patients, who face a significantly higher risk of complications, including pulmonary embolism (PE). The physiopathological particularities of oncological patients, combined with chemotherapy effects, and poor performance status, contribute to a prothrombotic state, making VTE either the first manifestation of cancer or a complication of its treatment. Purpose This study aims to analyze the incidence and risk factors of paraneoplastic DVT and evaluate the role of multidisciplinary management in improving patient outcomes. Methods A retrospective analysis was conducted using data from an emergency hospital. The study included patients diagnosed with DVT, evaluating their risk factors and therapeutic approaches. The methodology incorporated clinical assessments, laboratory markers, and imaging techniques, focusing on the impact of neoplasia on thrombotic complications. Results This study retrospectively analyzed 100 patients diagnosed with DVT, categorizing them into two cohorts based on the presence or absence of an associated neoplasia. Of the total study population, 25% had a concomitant malignancy, with colorectal (26%), uterine (20%), and lung cancers (16%) being the most frequently identified. Among patients with malignancy, 56% also exhibited PE, demonstrating the high thrombotic burden in this subgroup. Gastrointestinal and pulmonary cancers were more frequently associated with isolated DVT. Gynecologic cancers (uterine, ovarian, and cervical) exhibited a higher incidence of concurrent DVT and PE, possibly due to local compression of venous structures and estrogen-related coagulation changes. Cerebral malignancies showed a higher incidence of proximal DVT, with an increased likelihood of recurrent thrombotic events. Patients with metastatic cancer (60%) had a significantly increased risk of bilateral PE, reflecting the hypercoagulability associated with advanced disease. In 25% of cases, VTE was the first manifestation of an undiagnosed malignancy, reinforcing the concept of thrombosis as a paraneoplastic syndrome. The highest proportion of newly diagnosed cancers following a thrombotic event was observed in colorectal, lung, and cervical malignancies, suggesting a need for systematic cancer screening in unprovoked DVT cases. The recurrence rate of DVT was significantly higher in the oncologic cohort (50% in patients under 50 years old). Patients with colorectal cancer and PE had the highest mortality rates, reflecting the advanced nature of disease at diagnosis. Conclusions Paraneoplastic DVT represents a major challenge due to its high incidence, recurrence, and associated mortality. Early detection and risk stratification are essential in improving patient prognosis.