Background/Aims: To evaluate the short-term outcome of the decision taken by the Hepatoma Board for the treatment of Hepatocellular carcinoma (HCC). Materials and Methods: This was a prospective descriptive study involving 74 patients with HCC diagnosed by the known criteria. The decisions taken by the Hepatoma Board for the 74 patients were as follows: 1- surgical resection (7 patients), 2- local ablative therapy (LAT) (22 patients), 3- conventional transarterial chemoembolization (TACE) (24 patients), and 4- palliative supportive care (21 patients). Results: The short-term mortality rate was 25.7% of the total patients. The success rate was nearly equal in LAT (68.2%) and surgery (71.4%), whereas the success rate was approximately 33.3% in TACE. There was no difference in the mean total bilirubin level before and after LAT, surgery, or TACE (p>0.05 for each). There was a significant decrease in the mean serum albumin level after TACE (p=0.000). There was a decrease in the mean alpha fetoprotein level after surgery and LAT (p=0.033) for surgery and (p=0.048) for LAT. Conclusion: The management of HCC is better performed through a multidisciplinary team decision. Surgery has comparable outcome to LAT but is more invasive. According to our local experience, conventional TACE has a success rate of 33.3%.

Background/Aims: To evaluate the short-term outcome of the decision taken by the Hepatoma Board for the treatment of Hepatocellular carcinoma (HCC). Materials and Methods: This was a prospective descriptive study involving 74 patients with HCC diagnosed by the known criteria. The decisions taken by the Hepatoma Board for the 74 patients were as follows: 1- surgical resection (7 patients), 2- local ablative therapy (LAT) (22 patients), 3- conventional transarterial chemoembolization (TACE) (24 patients), and 4- palliative supportive care (21 patients). Results: The short-term mortality rate was 25.7% of the total patients. The success rate was nearly equal in LAT (68.2%) and surgery (71.4%), whereas the success rate was approximately 33.3% in TACE. There was no difference in the mean total bilirubin level before and after LAT, surgery, or TACE (p>0.05 for each). There was a significant decrease in the mean serum albumin level after TACE (p=0.000). There was a decrease in the mean alpha fetoprotein level after surgery and LAT (p=0.033) for surgery and (p=0.048) for LAT. Conclusion: The management of HCC is better performed through a multidisciplinary team decision. Surgery has comparable outcome to LAT but is more invasive. According to our local experience, conventional TACE has a success rate of 33.3%.

Background: The aim of this study was the evaluation of safety and outcome of temporal clamping of coronary artery in comparison to intraluminal coronary shunting, during distal anastomosis in off-pump coronary artery bypass grafting (CABG). Methods: To evaluate the early outcome of coronary clamping, we randomly compared the results of 25 patients submitted to coronary clamping using microvascular clamps during off-pump CABG (group A), with the results of another 25 patients had traditional intraluminal coronary shunting during same procedure (group B). All patients proved to have coronary artery disease with no difference between the groups in preoperative clinical variables. Results: Clamp group (A) had significant shorter operative time than shunt group (B); it was 224.2 ± 44.1 min in group (A) versus 250.4 ± 33.7 in group (B). Our new coronary clamp was applied in (93%) of target vessels but coronary shunt was implanted in (96%) of target vessels during distal coronary anastomosis. Clamp group (A) had low number of patients who required inotropic support (adrenaline > 0.15 mg/kg/min) > 24 Hours during perioperative period. The study showed two cases of mortality in both groups. At 6 months follow up; no difference between both groups was found, but late postoperative ejection fraction in group (A) was better, when compared to group (B). Conclusions: Temporal coronary clamping technique may be used as an applicable option to create a bloodless field during off-pump CABG surgery. It seems to be faster and cheaper than intraluminal shunting. Also, it has the same complications, mortality and ICU stay.

Background: The CHADS2 and CHA2DS2VASc and scoring systems were designed to stratify thromboembolic risk in patients with atrial fibrillation (AF). All the components of CHA2DS2VASc are important risk and prognostic factors for cardiovascular disease. This study evaluates the effectiveness and accuracy of CHA2DS2VASc score as a risk-stratification tool for in hospital and short-term clinical outcome in ST-elevation myocardial infarction (STEMI) patients. Materials and methods: Our study involved 171 patients admitted with STEMI regardless of presence or absence of AF.GRACE, TIMI and CHA2DS2VASc scores were calculated to all patients at hospital admission. Patients were divided into three groups (score0-2, 3-4 and ≥5) according to CHA2DS2VASc RS .The primary end point was major adverse cardiovascular events (MACE) including cardiovascular death, non- fatal myocardial infarction (MI), and stroke during hospital admission at 3 months and 6 months. The area under the receiver operating characteristic curve (AUC) was used to evaluate the predictive ability of each score at different time points. Results: Our six months follow up was completed in all patients. Cumulative incidence of MACE was 29 cases. In chi-square analysis, incidence of MACE was significantly higher in patients with CHA2DS2VASc score ≥5compared to3–4and 0–2 (38.89% vs19.57% vs12.15%, P = 0.01).Death is the most significant complication (p0.001). Both TIMI score and GRACE RS didn't demonstrate better discrimination than CHA2DS2VASc risk score in predicting in-hospital, 3-month and 6-month MACE. Conclusion: Our study demonstrates that CHA2DS2VASc score is an independent predictor for short-term prognosis in STEMI patients and can be used as a risk-stratification system in STEMI patients irrespective of method of treatment.

Background: The CHADS2 and CHA2DS2VASc and scoring systems were designed to stratify thromboembolic risk in patients with atrial fibrillation (AF). All the components of CHA2DS2VASc are important risk and prognostic factors for cardiovascular disease. This study evaluates the effectiveness and accuracy of CHA2DS2VASc score as a risk-stratification tool for in hospital and short-term clinical outcome in ST-elevation myocardial infarction (STEMI) patients. Materials and methods: Our study involved 171 patients admitted with STEMI regardless of presence or absence of AF.GRACE, TIMI and CHA2DS2VASc scores were calculated to all patients at hospital admission. Patients were divided into three groups (score0-2, 3-4 and ≥5) according to CHA2DS2VASc RS .The primary end point was major adverse cardiovascular events (MACE) including cardiovascular death, non- fatal myocardial infarction (MI), and stroke during hospital admission at 3 months and 6 months. The area under the receiver operating characteristic curve (AUC) was used to evaluate the predictive ability of each score at different time points. Results: Our six months follow up was completed in all patients. Cumulative incidence of MACE was 29 cases. In chi-square analysis, incidence of MACE was significantly higher in patients with CHA2DS2VASc score ≥5compared to3–4and 0–2 (38.89% vs19.57% vs12.15%, P = 0.01).Death is the most significant complication (p0.001). Both TIMI score and GRACE RS didn't demonstrate better discrimination than CHA2DS2VASc risk score in predicting in-hospital, 3-month and 6-month MACE. Conclusion: Our study demonstrates that CHA2DS2VASc score is an independent predictor for short-term prognosis in STEMI patients and can be used as a risk-stratification system in STEMI patients irrespective of method of treatment.

Background: The CHADS2 and CHA2DS2VASc and scoring systems were designed to stratify thromboembolic risk in patients with atrial fibrillation (AF). All the components of CHA2DS2VASc are important risk and prognostic factors for cardiovascular disease. This study evaluates the effectiveness and accuracy of CHA2DS2VASc score as a risk-stratification tool for in hospital and short-term clinical outcome in ST-elevation myocardial infarction (STEMI) patients. Materials and methods: Our study involved 171 patients admitted with STEMI regardless of presence or absence of AF.GRACE, TIMI and CHA2DS2VASc scores were calculated to all patients at hospital admission. Patients were divided into three groups (score0-2, 3-4 and ≥5) according to CHA2DS2VASc RS .The primary end point was major adverse cardiovascular events (MACE) including cardiovascular death, non- fatal myocardial infarction (MI), and stroke during hospital admission at 3 months and 6 months. The area under the receiver operating characteristic curve (AUC) was used to evaluate the predictive ability of each score at different time points. Results: Our six months follow up was completed in all patients. Cumulative incidence of MACE was 29 cases. In chi-square analysis, incidence of MACE was significantly higher in patients with CHA2DS2VASc score ≥5compared to3–4and 0–2 (38.89% vs19.57% vs12.15%, P = 0.01).Death is the most significant complication (p0.001). Both TIMI score and GRACE RS didn't demonstrate better discrimination than CHA2DS2VASc risk score in predicting in-hospital, 3-month and 6-month MACE. Conclusion: Our study demonstrates that CHA2DS2VASc score is an independent predictor for short-term prognosis in STEMI patients and can be used as a risk-stratification system in STEMI patients irrespective of method of treatment.

Introduction: Acute heart failure (AHF) complicates acute Myocardial infarction (AMI) as a result of complex interaction of structural, hemodynamic, neurohormonal, and genetic maladaptations. This study aims to analyse the role of left atrial volume index (LAVI) compared to other conventional parameters of systolic and diastolic left ventricular function in patients with first time STEMI, in predicting in-hospital heart failure, in-hospital mortality and development of heart failure and mortality over a follow up period of 6 months. Material and Methods: The present study is a prospective observational study conducted in the cardiology department of Assiut University Hospitals (AUH) on 70 STEMI patients admitted to coronary care unit (CCU). LVEF, LV wall dimensions, left atrial volume index, diastolic and systolic parameters were measured within 24 hours after admission and then 6 months later. These variables were correlated with development of heart failure according to Killip classification on admission and 6 months later by NYHA classification. Results: There was a statistically significant difference regarding development of in-hospital heart failure (Killip classification > II) with the following variables LAV, LAVI, LVESD, FS, EF, and the diastolic parameters used to evaluate diastolic function whereas in-hospital mortality was related significantly to the same variables except LAVI, E/A ratio and EF by univariate analysis. Six months later, follow up of our patients revealed a statistically significant relation between mortality development and the following variables; LAVI, EF, E/A ratio, DT, IVRT, TDI Septal e` and E/e` by univariate analysis. A statistically significant relation between development of heart failure symptoms according to NYHA classification and subsequent admission was observed with the previously mentioned variables except DT and IVRT by univariate analysis. Regarding LAVI, EF, E/A ratio, TDI septal é and E/é ratio as predictors of both in-hospital heart failure and mortality, all five variables had a statistically significant relation with development of in-hospital heart failure, but only TDI septal é and E/é ratio were significantly related to in-hospital mortality. All the previously mentioned five variables were related also to development of mortality or symptoms of heart failure and readmission over six months follow up. Using multiple regression analysis, LAVI ml/m2, E/e` ratio, EF were the most significant predictors of in-hospital heart failure with E/e` ratio being the most powerful predictor. Conclusions: LAVI and other determinants of systolic and diastolic functions of the heart played an important role in prediction of heart failure and mortality both in the in-hospital setting and after a follow up period of 6 months. LAVI, E/e` ratio and EF are the most significant predictors of in hospital heart failure with E/e` ratio being the most powerful predictor. LAVI and EF were the most powerful predictors of mortality and heart failure during a follow up period of 6 months respectively.

Introduction: Acute heart failure (AHF) complicates acute Myocardial infarction (AMI) as a result of complex interaction of structural, hemodynamic, neurohormonal, and genetic maladaptations. This study aims to analyse the role of left atrial volume index (LAVI) compared to other conventional parameters of systolic and diastolic left ventricular function in patients with first time STEMI, in predicting in-hospital heart failure, in-hospital mortality and development of heart failure and mortality over a follow up period of 6 months. Material and Methods: The present study is a prospective observational study conducted in the cardiology department of Assiut University Hospitals (AUH) on 70 STEMI patients admitted to coronary care unit (CCU). LVEF, LV wall dimensions, left atrial volume index, diastolic and systolic parameters were measured within 24 hours after admission and then 6 months later. These variables were correlated with development of heart failure according to Killip classification on admission and 6 months later by NYHA classification. Results: There was a statistically significant difference regarding development of in-hospital heart failure (Killip classification > II) with the following variables LAV, LAVI, LVESD, FS, EF, and the diastolic parameters used to evaluate diastolic function whereas in-hospital mortality was related significantly to the same variables except LAVI, E/A ratio and EF by univariate analysis. Six months later, follow up of our patients revealed a statistically significant relation between mortality development and the following variables; LAVI, EF, E/A ratio, DT, IVRT, TDI Septal e` and E/e` by univariate analysis. A statistically significant relation between development of heart failure symptoms according to NYHA classification and subsequent admission was observed with the previously mentioned variables except DT and IVRT by univariate analysis. Regarding LAVI, EF, E/A ratio, TDI septal é and E/é ratio as predictors of both in-hospital heart failure and mortality, all five variables had a statistically significant relation with development of in-hospital heart failure, but only TDI septal é and E/é ratio were significantly related to in-hospital mortality. All the previously mentioned five variables were related also to development of mortality or symptoms of heart failure and readmission over six months follow up. Using multiple regression analysis, LAVI ml/m2, E/e` ratio, EF were the most significant predictors of in-hospital heart failure with E/e` ratio being the most powerful predictor. Conclusions: LAVI and other determinants of systolic and diastolic functions of the heart played an important role in prediction of heart failure and mortality both in the in-hospital setting and after a follow up period of 6 months. LAVI, E/e` ratio and EF are the most significant predictors of in hospital heart failure with E/e` ratio being the most powerful predictor. LAVI and EF were the most powerful predictors of mortality and heart failure during a follow up period of 6 months respectively.

Introduction: Acute heart failure (AHF) complicates acute Myocardial infarction (AMI) as a result of complex interaction of structural, hemodynamic, neurohormonal, and genetic maladaptations. This study aims to analyse the role of left atrial volume index (LAVI) compared to other conventional parameters of systolic and diastolic left ventricular function in patients with first time STEMI, in predicting in-hospital heart failure, in-hospital mortality and development of heart failure and mortality over a follow up period of 6 months. Material and Methods: The present study is a prospective observational study conducted in the cardiology department of Assiut University Hospitals (AUH) on 70 STEMI patients admitted to coronary care unit (CCU). LVEF, LV wall dimensions, left atrial volume index, diastolic and systolic parameters were measured within 24 hours after admission and then 6 months later. These variables were correlated with development of heart failure according to Killip classification on admission and 6 months later by NYHA classification. Results: There was a statistically significant difference regarding development of in-hospital heart failure (Killip classification > II) with the following variables LAV, LAVI, LVESD, FS, EF, and the diastolic parameters used to evaluate diastolic function whereas in-hospital mortality was related significantly to the same variables except LAVI, E/A ratio and EF by univariate analysis. Six months later, follow up of our patients revealed a statistically significant relation between mortality development and the following variables; LAVI, EF, E/A ratio, DT, IVRT, TDI Septal e` and E/e` by univariate analysis. A statistically significant relation between development of heart failure symptoms according to NYHA classification and subsequent admission was observed with the previously mentioned variables except DT and IVRT by univariate analysis. Regarding LAVI, EF, E/A ratio, TDI septal é and E/é ratio as predictors of both in-hospital heart failure and mortality, all five variables had a statistically significant relation with development of in-hospital heart failure, but only TDI septal é and E/é ratio were significantly related to in-hospital mortality. All the previously mentioned five variables were related also to development of mortality or symptoms of heart failure and readmission over six months follow up. Using multiple regression analysis, LAVI ml/m2, E/e` ratio, EF were the most significant predictors of in-hospital heart failure with E/e` ratio being the most powerful predictor. Conclusions: LAVI and other determinants of systolic and diastolic functions of the heart played an important role in prediction of heart failure and mortality both in the in-hospital setting and after a follow up period of 6 months. LAVI, E/e` ratio and EF are the most significant predictors of in hospital heart failure with E/e` ratio being the most powerful predictor. LAVI and EF were the most powerful predictors of mortality and heart failure during a follow up period of 6 months respectively.

Introduction: Acute heart failure (AHF) complicates acute Myocardial infarction (AMI) as a result of complex interaction of structural, hemodynamic, neurohormonal, and genetic maladaptations. This study aims to analyse the role of left atrial volume index (LAVI) compared to other conventional parameters of systolic and diastolic left ventricular function in patients with first time STEMI, in predicting in-hospital heart failure, in-hospital mortality and development of heart failure and mortality over a follow up period of 6 months. Material and Methods: The present study is a prospective observational study conducted in the cardiology department of Assiut University Hospitals (AUH) on 70 STEMI patients admitted to coronary care unit (CCU). LVEF, LV wall dimensions, left atrial volume index, diastolic and systolic parameters were measured within 24 hours after admission and then 6 months later. These variables were correlated with development of heart failure according to Killip classification on admission and 6 months later by NYHA classification. Results: There was a statistically significant difference regarding development of in-hospital heart failure (Killip classification > II) with the following variables LAV, LAVI, LVESD, FS, EF, and the diastolic parameters used to evaluate diastolic function whereas in-hospital mortality was related significantly to the same variables except LAVI, E/A ratio and EF by univariate analysis. Six months later, follow up of our patients revealed a statistically significant relation between mortality development and the following variables; LAVI, EF, E/A ratio, DT, IVRT, TDI Septal e` and E/e` by univariate analysis. A statistically significant relation between development of heart failure symptoms according to NYHA classification and subsequent admission was observed with the previously mentioned variables except DT and IVRT by univariate analysis. Regarding LAVI, EF, E/A ratio, TDI septal é and E/é ratio as predictors of both in-hospital heart failure and mortality, all five variables had a statistically significant relation with development of in-hospital heart failure, but only TDI septal é and E/é ratio were significantly related to in-hospital mortality. All the previously mentioned five variables were related also to development of mortality or symptoms of heart failure and readmission over six months follow up. Using multiple regression analysis, LAVI ml/m2, E/e` ratio, EF were the most significant predictors of in-hospital heart failure with E/e` ratio being the most powerful predictor. Conclusions: LAVI and other determinants of systolic and diastolic functions of the heart played an important role in prediction of heart failure and mortality both in the in-hospital setting and after a follow up period of 6 months. LAVI, E/e` ratio and EF are the most significant predictors of in hospital heart failure with E/e` ratio being the most powerful predictor. LAVI and EF were the most powerful predictors of mortality and heart failure during a follow up period of 6 months respectively.