Abstract: Heart Failure (HF) is a disease whose prevalence is increasing in developed countries, involving up to 10% of the older population; the increase is due both to better therapy and to the aging population. Fifty percent (50%) of these patients are women, most of them presenting with preserved systolic function and diastolic dysfunction. Female patients show different etiology to males; they present several comorbidities and at an older age. Despite this, women appear to have a lower mortality risk, and female gender is an independent prognostic factor for better survival. An explanation for this different presentation and prognosis may be different ventricular remodeling in response to pressure burden on the left ventricle, leading to completely different left ventricular geometry and compliance mechanisms. These differences are not only detectable at macroscopic examinations but also appear in microscopic gene and molecular expression, with a reduction in apoptosis during lifetime and a lower myocyte volume. Although all these mechanisms have a protective role in chronic HF, different remodeling in women leads to a weak balance in the acute setting, with an imbalance between compensatory mechanisms and higher cardiac output requirements. This impairment goes along with the loss of “female gender advantage” after hospitalization. Despite the peculiar presentation of HF in women, there is little evidence about therapy in this setting, due to under-representation of women in clinical trials and the absence of sex-specific, prospective randomized trials.

Abstract: Median arcuate ligament syndrome is considered as rare syndrome manifested by variety of symptoms. Aim of the Work: To assess the presence of asymptomatic patients showing the typical color duplex ultrasound and CT angiographic features of MAL syndrome and the impact of these findings on the pathogenesis and management of the syndrome. Material and Methods: 200 asymptomatic patients were examined with color duplex ultrasound and further CT angiography was performed to all patients with color duplex findings of arcuate ligament syndrome. Results: 8 patients showed typical color duplex findings and CT angiographic features of MALS. Conclusion: The diagnosis of MAL syndrome shouldn't depend only on the imaging criteria and should be strongly linked to the unexplained patient symptoms after meticulous exclusion of other etiologies. The management shouldn’t depend only on relieving the arterial stenosis but also on dissection of peri arterial nerve plexus.

Abstract: Background: Cardiac resynchronization therapy (CRT) has been introduced as a promising therapeutic choice in heart failure patients (HF) with ventricular dyssynchrony, shown with a wide QRS. Objective: This study aimed to evaluate the effect of CRT on the severity of mitral regurgitation (MR) quantitatively using the volumetric Doppler method in HF patients. Patients and methods: This was a prospective before-after survey in which 22 HF patients with wide QRS (≥120 ms) and NYHA class III who were included. All patients were evaluated initially for QRS width, NYHA class, MR volume, MR fraction HF and mitral valve area (MV area). Biventricular pacing was done through cardiac-resynchronization device along with three pacing leads and same evaluations were done after CRT. Results: The mean (SD) QRS width and NYHA class were significantly decreased after CRT in HF patients (P<0.001). Also MR volume (46.9±30.2cc vs. 27.0±26.4cc, P<0.001) and fraction (40.1±25.5% vs. 26.8±22.7%, P=0.002) were improved following CRT. The decrease of MV area after CRT was also significant (10.6±3.0cm² vs. 8.6±2.6cm², P<0.001). Conclusion: As MR is associated with morbidity and mortality in HF patients and the standard surgical therapy may not be practical for a majority of them, this novel treatment may improve their disease condition significantly.

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.