Background: We have shown the ratio of systole to diastole to be a valuable global index of ventricular dysfunction in pediatric dilated and restrictive cardiomyopathy and also of ventricular function of the single systemic right ventricle in children who have undergone Norwood procedure for hypoplastic left heart. As this index may be a valuable indicator of ventricular performance in other conditions, normal reference values need to be established. The purpose of this study was to establish normal values for the S/D ratio in children and to investigate its relation to heart rate, age and body surface area. Methods: We reviewed 179 echocardiograms of healthy children and young adults (mean: 70.18 months, SD: ± 65.12 months, range 0.02 months to 19 years) and measured the average duration of the holosystolic tricuspid regurgitant jet (systolic interval). The remainder of the cardiac cycle (i.e the period between 2 tricuspid regurgitant jets) was defined as the diastolic interval. We evaluated the relation between the S/D ratio and heart rate, age and body surface area by univariate and multivariate linear regression analysis. Results: Ranges, mean values and standard deviations are reported from age 0.02 months to 19 years (70.18 ± 65.12 months), BSA 0.11 to 2.51m² (0.85 ± 0.55) and heart rate 50 to 156 bpm (96.72 ± 23.19). The systolic period ranged between 208.5 to 467 msec (314.08 ± 52.57) and the diastolic period between 166.5 to 809 msec (341.34 ± 129.61) yielding a S/D ratio between 0.397 to 1.62 (0.995 ± 0.23). The S/D ratio correlated positively with heart rate (y = 0.0073x+0.2969, r = 0.72). However, in multivariate analysis there was no significant correlation with age and body surface. Heart rate had a greater effect on shortening the diastolic period, in an exponential fashion (y = 130679x -1.3232, r = -0.88) than on systolic period which responded in linear fashion (y = -1.9228x + 500.05, r = -0.85). Conclusions: We provide normal reference values for the S/D ratio across a wide range of heart rates in children, adolescents and young adults.

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Since its identification as a group of cardiovascular risk factors that frequently cluster together, the metabolic syndrome has been the subject of controversy. Several definitions exist, and some commentators claim that the diagnosis of the metabolic syndrome may not even be clinically useful. Nevertheless, it is clear that the factors that comprise the syndrome-elevated levels of triglycerides, low levels of high-density lipoprotein cholesterol, elevated blood pressure, elevated blood glucose, and abdominal obesity-even considered individually, increase the risk for cardiovascular disease and need to be treated, and that risk increases with the number of risk factors present. This review will discuss the predictive value and approaches to treatment of each of the risk factors comprising the metabolic syndrome and will provide a justification for that designation. In addition, it will pose several questions that remain to be answered in order for us to provide optimal prevention strategies and treatment for this increasingly prevalent syndrome adults.

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Backgrounds: The use of certain medications in acute myocardial infarction (AMI) is known to lower morbidity and mortality. We aimed to evaluate, through the use of performance measures, the implementation of specific guidelines-recommended pharmacotherapy in the management of AMI in patients living in the Arabian Peninsula. Materials and Methods: The Gulf Registry of Acute Coronary Events (Gulf RACE) enrolled ACS patients from 6 countries in the Arabian Peninsula. We examined the use of 7 performance measures that relate to the management of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Results: 5833 AMI patients were enrolled in Gulf RACE. In the first 24 hours of hospital arrival, 5713 (98%) patients were administered aspirin. The prescription rate at discharge was 5376 (97%) for aspirin, 4354 (78%) for beta-blockers, 5639 (84%) for statins and 3145 (57%) for clopidogrel. Left ventricular systolic function (LVSF) was evaluated in 3861 (66%) patients. Of those who had ejection fraction < 40% (921 patients), 725 (85%) received angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) at discharge. Conclusion: There was good adherence to guidelines-recommended medications in patients admitted to hospital with a diagnosis of AMI. The implementation of more performance measures need to be evaluated in order to assess the full picture of AMI management in this part of the world.

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