Objectives: The significance of reciprocal changes distribution in acute pericarditis has not been studied yet. We evaluated the significance of reciprocal changes distribution in leads V1 and AVR in differentiating acute pericarditis from myocardial infarction. Methods: A retrospective case control study done on 240 pateitns wih AP only 76 patients who had ST elevation ECG changes were included in the study, compared to another Control group of 80 patients with documented acute myocardial infarction (AMI). Results: The reciprocal changes in leads AVR and V1 ± III was the most sensitive and specific ECG findings for the diagnosis of AP, sensitivity of 68% and specificity of 98% P < 0.001. Moreover PR segment depression P < 0.26, ST/T wave ratio P < 0.33, shape of ST segment P = 0.49, ST segment axis P = 0.11, were not found to be sensitive nor specific for the diagnosis of AP. However the diffuse ST segment elevation was suggestive of AP with sensitivity of 51% and specificity of 97.5%, P < 0.001. Conclusion: This study showed that the reciprocal changes in the leads V1, AVR, ± leads III are more sensitive and specific than the PR segment depression, ST segment shape, ST/T wave ratio, ST segment axis. For the diagnosis of AP, and it can be useful tool to differentiate AP from AMI.

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Objectives: We investigated the impact of six month cardiac resynchronization therapy (CRT) on echocardiographic and clinical variables in congestive heart failure patients (CHF). Background: Cardiac resynchronization reduces symptoms and improves left ventricular function in many patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony1. We evaluated its short term effects on reverse remodeling of the left ventricle and on the patient symptoms. Methods: The evaluated group contains seven patients (1 woman and 6 men). The average age was 62.43 ± 21.9 years. All the patients had CHF with prolonged QRS. The etiology was ischemic in 5 and idiopathic in 2. All patients underwent physical examination and six minutes hall walk test. Echocardiography was done to evaluate basic cardiac function, left ventricular ejection fraction (LVEF, M-mode & Simpson), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), MR severity and dysynchrony by Doppler and tissue Doppler. Results were compared before implantation and six weeks and six month after CRT implantation. Results: LVEDD and LVESD were reduced after six months, LVEDD was reduced from 75.9 ± 7.4 to 71.0 ± 4.1 mm ± SD (p value 0.04) and LVESD was reduced from 62.4 ± 8.5 to 59.3 ± 7.0 (p value 0.15). Ejection fraction was significantly increased after 6 weeks from 25 ± 7.1% to 31 ± 4.5%, (p value 0.03).The average grade of mitral regurgitation has increased from 1.67 ± 0.82 at baseline to 1.75 ± 0.88 at 6 month follow up, (p value 0.66) by semi-quantitative analysis. Conclusion: Although the study was performed on a small number of patients, yet we are convinced that Cardiac resynchronization therapy had favorable hemodynamic and clinical results in our heart failure patients.

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Background: Balloon mitral valvuloplasty (BMV) has been successfully performed in patients with symptomatic mitral stenosis. In this study, we evaluate the safety, efficacy and outcome of BMV here in Oman. Methods: The immediate and one year clinical and echocardiographic results of 89 consecutive patients (mean age 34 ± 12 years) who underwent BMV for severe mitral stenosis between January 1997 and June 2007 are reported. Results: The procedure was considered successful in 86 (96%) patients. The hemodynamic mean diastolic gradient decreased from 15.4 ± 5.7 mmHg to 3.4 ± 2.9 mmHg (p < 0.0001). The mean left atrial pressure was reduced from 24 ± 7.1 mmHg to 11.6 ± 3.6 mmHg (p < 0.0001).The mean mitral valve area assessed by 2-D echocardiography increased from 0.9 ± 0.22 cm2 to 1.7 ± 0.26 cm2 (p < 0.0001). Three patients (3.3%) developed moderate to severe mitral regurgitation. Two patients expired, one due to severe mitral regurgitation and another due to sepsis unrelated to the procedure. The one year follow up mean mitral valve area was 1.6 ± 0.24 cm2, restenosis rate was 23%; and 90% of patients were in class I - II. Conclusion: The results of this study show that BMV is a safe and effective procedure for symptomatic mitral stenosis in a low volume center with lower complication rates and good clinical improvement.

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