Abstract: Atrial fibrillation (AF) is the most frequent arrhythmia, and patients frequently visit emergency departments, where the condition might be diagnosed for the first time. An analysis of factors that might lead a chronic patient to seek urgent medical treatment is important, especially in terms of preventing long-term disability and morbidity. This is even truer for atrial fibrillations, whose complications have a known notoriety and are source of important mortality figures, mainly related to ischemic stroke or more serious consequential cardiac arrhythmias. We have studied paroxysmal AF cases treated during a period of two months in an emergency facility of the University Hospital Centre of Tirana, with 106 patients recruited sequentially in a prospective, open-label and descriptive study. Our data confirmed an important association between overweight and obesity and paroxysmal AF in general, since more than 80% of the patients suffering from this condition had a high body mass index. A thorough discussion of the data, confronted with much larger studies reported from several sources and available actually, is made at the end of the paper. The necessity to re-confirm findings through larger groups of study and through a multi-centre design is formulated.

Abstract: Metabolic syndrome is a term, which refers to a combination of medical disorders that are associated with a higher risk for cardiovascular disease and diabetes. The syndrome is more common in female than males. This study was conducted to estimate the prevalence of the metabolic syndrome among patients with cardiovascular diseases in Gaza and to examine the association between traditional risk factors for the non-communicable diseases and each of the component of the metabolic syndrome. We used the Adult Treatment Protocol III National cholesterol Education Programme of America (ATPIII) indicators for diagnosis and determination of metabolic syndrome. The syndrome was met if an individual had three or more criteria: waist circumference >102cm in men and >88cm in women, fasting plasma glucose ≥110mg/dl, Blood pressure ≥130/85mmhg, serum Triglycerides ≥150mg/dl and serum HDL cholesterol <40mg/dl in male and <50mg/dl in female. Statistical analysis was performed using SPSS version 20. The prevalence of metabolic syndrome was 59.5%, without difference between male and female. The main risk factors for metabolic syndrome were high blood pressure (78.8% for systolic and 73.8% for diastolic Blood Pressure), large waist circumference (67.9%), high Triglycerides (78.6%), and high fasting blood sugar (86.4%). HDL cholesterol was protective but not statistically significant. The risk factors of metabolic syndrome in both sexes in descending order were as follows, high fasting blood sugar, large waist circumference, high Triglycerides, high Blood Pressure, and low HDL cholesterol. We conclude that high level of prevalence of metabolic syndrome in our study population indicates the need for an active health programme to reduce the factors influencing the prevalence. Therefore, preventive interventions must be taken seriously.

Abstract: Background: Atherosclerotic coronary artery disease is a major cause of death all over the world. Among patients with coronary artery disease, there are different cardiovascular risk factors which may exhibit their effects on coronary angiographic findings. This work aimed to study the relation of different cardiovascular risk factors with coronary angiographic findings in patients with ischemic heart disease (IHD). Methods: This case-series prospective study involved 220 patients with IHD who underwent coronary angiography in Mosul Cardiac Catheterization Unit in Ibn-Sina Teaching Hospital over a period of five months from April 1^st through August 31^st 2006. Patients with different coronary risk factors including smoking, positive family history of IHD, type 2 diabetes mellitus (T2DM), hypertension (HT), dyslipidemia, obesity and physical inactivity who presented with IHD were categorized and compared according to presentations into; ST-elevation myocardial infarction (STEMI) ( n = 72), Non-ST-elevation myocardial infarction (NSTEMI) and/or unstable angina (n = 98) and chronic stable angina (n = 50) and then the patients were re-grouped according to the number of cardiovascular risk factors into patients with < 3 risk factors (n = 125) vs. those with > 3 risk factors (n = 95). Results: There were significant associations between the risk factors and the angiographic characteristics in patients with IHD. There were more significantly stenosed lesions among patients with > 3 risk factors compared to patients with < 3 risk factors (p < 0.05). Lesions were more diffused (p < 0.01), with higher incidence of left ventricular dysfunction (p < 0.001) among former patients compared to later ones. Conclusions: Significant findings were observed in the angiographic profile of patients with multiple risk factors. There were more multi-vessels and diffused angiographic findings among patients with chronic stable angina.

Abstract: Background: Aortic valve stenosis causes gradual obstruction to left ventricular outflow tract. It is a common valvular disease that carries many life threatening complications. We hypothesized that the reduction or elimination of the pressure gradient across the aortic valve after correction of the stenotic lesion would lead to regression of left ventricular mass and improve left ventricular functions. Aim of the work is to assess the effectiveness of the correction and factors controlling these changes in left ventricular mass index and functions. Methods: preoperative and postoperative Electro-cardiography and echocardiography were performed for all patients. The corrective procedures included aortic valve replacement, balloon aortic valvuloplasty and open valve repair. Results: Sixty patients had correction of aortic valve stenosis (44 males, 16 females). ECG score preoperatively ranged between3 and 9 with a mean of 6 ± 1.63. Postoperatively, it ranged between 0 and 6 and mean of 3 ± 0.7. The mean LVED/BSA was reduced from 32.52 preoperatively to 30.41 postoperatively. The mean interventricular septal thickness index was reduced by 1.03. The mean left ventricular posterior wall thickness index was reduced by 0.99. Mean left ventricular mass index was reduced by 31.86 gm. The mean ejection fraction increased by 6.45. Mean trans-aortic peak gradient was reduced by 41.36 mmHg. Conclusions: Correction of aortic valve stenosis improves systolic and diastolic left ventricular function and a reduction in left ventricular mass index. Aortic root enlargement procedures can be safely avoided.

Abstract: Chronic anemia is a risk factor for cardiovascular diseases outcome in patients with heart failure, dilated cardiomyopathy and uncontrolled hypertension. This study was performed to analyze the prevalence of anemia among cardiac patients and to determine the relationship between anemia and socio demographic characteristics. The study design is a cross sectional based on 300 cardiac patients ( ≥ 19 years) who were hospitalized in ALShifa hospital (Gaza) for 3 months period during the year 2012. The analysis includes socio demographic data, traditional risk factors for cardiovascular diseases (CVD), and Laboratory test included (hemoglobin and clearance creatinine measurement). Collected data was analyzed by using statistical package for social science version 20.0. Anemia was defined as Hemoglobin less than < 12 g/dl in female and less than 13 g/dl in male based on World health organization criteria. Among 300 patients, 181patients (60.3%) were anemic and 119 (39.7%) were non-anemic. The mean age for all population was 61.4 years. Mean age of patients with anemia tends to be higher (63.9 years) than non-anemic (57.7 years) and the differences between the two means reached statistical significant level (P value < 0.001). Anemia was more common in female (71.4%), older age (71.1%), diabetics (70%), impaired clearance creatinine (70%), hypertensive’s (65%) and low education level (64.5%). The highest proportion belonged to valvular heart disease (77.8%), congestive heart failure (74.6%) followed by hypertension (54%), and the lowest is coronary artery disease (46%). Logistic regression reveals that low education, low clearance creatinine level, smoking and diabetes are independently associated with anemia. We conclude that Anemia is common among cardiovascular disease patients, and worsens the prognosis of their clinical condition. Intervention policies to minimize anemia risk factors are needed.