Study of the Diagnostic and Prognostic value of Fecal calprotectin for hepatic encephalopathy in Egyptian cirrhotic patients

Abstract

Ischemic heart disease (IHD) is the primary cause of morbidity and mortality in the industrialized countries. IHD involves a broad clinical spectrum, ranging from stable angina to sudden cardiac death. Although the death rate from IHD has decreased in the last 3 decades of the twentieth century, due to therapeutic improvements and prevention campaigns, the prevalence of IHD continues to increase over the first decade of this millennium. Worldwide, IHD will be the number one cause of death by 2020. Survivors of a first acute myocardial infarction (AMI) are thought to die of IHD at later ages due to heart failure and late cardiac deaths. Moreover, the increased lifespan will contribute to the increased incidence of cardiovascular disease and increased number of deaths from heart disease. Currently, three routinely available directions of HF treatment are available: medical treatment, heart transplantation, and revascularization. In daily clinical practice, the choice is frequently made between medical treatment and revascularization. From this perspective, Identification of irreversibly infarcted myocardium from dysfunctional, but viable and potentially salvageable myocardium after a heart attack is of crucial importance for the management of cardiac patients. In particular, revascularization of an infracted area by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is deemed justified only if functional recovery following the intervention is predictable, or if late outcome and patient well-being can be improved. A tremendous number of research studies, scientific papers, reviews, editorials, and books have elaborated the different aspects of this topic. In clinical practice it is not practical to assess myocardial viability by microscopy and histology, and The main value of noninvasive assessment of viability is in the more severely and chronically disabled patient, in whom the outcome without intervene Some information on myocardial viability can be derived from the surface electrocardiogram, but imaging is more contributing in this clinical setting. Several noninvasive imaging techniques have been developed to identify dysfunctional but viable tissue: dobutamine stress echocardiography, single-photon emission computed tomography (SPECT) imaging with thallium- 201 or technetium-99m-labeled tracers, and positron emission tomography (PET) metabolic imaging with 18F-fluorodeoxyglucose (18F-FDG). Magnetic resonance imaging (MRI) is another technique for assessment of myocardial viability is poor, but the risk of revascularization is high.

Accurate viability assessment is possible with CMR using different techniques including EDWT measurement, DSMR, and DECMR. While DSMR has the highest specificity to predict functional recovery post-revascularization, EDWT and DE-CMR have a higher sensitivity. MR imaging will normally be reserved to assess rest and/or stress LV function if further clarification is required after echocardiography and/or myocardial perfusion scintigraphy. However, if MR imaging is readily available, it is a good alternative to echocardiography for the assessment of rest and stress LV function. The advantages of evaluation by MRI, compared to other techniques, are represented by its non-invasiveness, the use of non-ionizing radiation, the independence from anatomical windows. In addition, MRI acquisition techniques can produce 3D reconstructions of the heart oriented on any plane of space, and with high contrast between muscular structures and blood, hence providing accurate and reproducible quantitative evaluations. MRI represents the complementary survey to echocardiography, especially when one wants to pass from a qualitative to a quantitative evaluation.